Creating a register of “serious and repeat offenders” as part of a new domestic abuse law, raising awareness of coercive control within families and improving crisis intervention must be prioritised, an independent review into the killing of an honorary police officer by her son has concluded.
Pamela Nisbet – described as a “wonderful wife, mother, grandmother and friend” – died after being stabbed at her home by Andrew Charles Nisbet, a former doctor, in August 2019.
He was sent to a secure unit specialised in autism care under an indeterminate treatment order from the Royal Court after admitting manslaughter last year.
He had been diagnosed with severe Autism Spectrum Disorder and Asperger Syndrome several years ago, and one of the doctors who looked after him in a previous facility also diagnosed an associated anxiety disorder and a probable diagnosis of mixed personality disorder.
Released today by the Safeguarding Partnership Board, a Domestic Homicide Review found that there had been a "history of concerning and dangerous behaviours" from Mr Nisbet at his mother's home, with police having been called several times. However, Mrs Nisbet did not want criminal charges brought against her son, but for his mental health to be addressed.
The review - which refers to Mr Nisbet under the pseudonym 'Steven' - also found that there had been three attempts to detain Mr Nisbet under the Mental Health Law, but that it was decided on the final attempt that the situation could be managed without detaining him.
Professor Jane Monckton Smith, a Professor of Public Protection at the University of Gloucestershire with a specialism in homicide, wrote in the report that while there was “little doubt” Mr Nisbet’s mental illness had played a role in her death, she had found that his mother had been subjected to “patterns of behaviour that fit the criteria for domestic violence and coercive control”, while other family members had also suffered“coercive control "of a serious and intense nature”.
She wrote that Mr Nisbet was “very antagonistic” towards his mum, whom he perceived as a “barrier” to him securing the annex at his parents’ house he wanted to occupy, despite them having provided a three-bedroom home in the island.
Her research found that Mrs Nisbet had voiced concerns over Mr Nisbet's mental health several times with her GP in 2018. The following year, the GP sought support from the Community Mental Health Nurse and the Adult Mental Health Services regarding the domestic situation and the risk of Mr Nisbet harming himself, respectively.
The police had also been in contact with the family since April 2019 and their address flagged with ‘treat calls as urgent’. However, there were no arrests, as Mrs Nisbet and her husband were reluctant to “criminalise” Mr Nisbet's behaviours.
After the couple issued an eviction notice, Mr Nisbet's harassment and abuse “escalated” and police had to be called on several occasions to remove him from his parents’ home when he refused to leave.
Pictured: Mrs Nisbet had voiced concerns about Mr Nisbet's mental health with her GP, who sought to get support from other services.
A GP and a consultant psychiatrist attempted to detain Mr Nisbet using Mental Health law. The first two attempts were postponed due to barriers created by Mr Nisbet, but at the third and final attempt, the authorised officer, a locum social worker, refused to allow the detention, as they believed the situation could be managed without detaining him. Professor Monckton-Smith said it was possible that this decision may have been taken without “full knowledge of the antecedents”, noting that the GP, the family and the police had expressed frustration over it.
Sadly, Mrs Nisbet was killed five days later.
Professor Monckton-Smith found the risk posed to Mrs Nisbet had not been fully recognised because the focus was on her son's mental health.
"...His distress, his self-harm and his wishes and demands" had all created a "smokescreen" around what was a recognisable and escalating pattern of domestic abuse and control suffered by Mrs Nisbet and her family, the review said.
The Professor note that Mr Nisbet had often threatened suicide to "achieve compliance" with his demands, and attempted to manipulate others into believing he was a victim of his mother. He also tried to control other family members, and professionals.
While authorities were aware of what was going on, the Professor said there was "little doubt" that the full extent of his behaviour had not been fully disclosed to professionals before Mrs Nisbet's death.
“It is a known and acknowledged response to domestic abuse and coercive control that victims of it will minimise their experiences and this can be for many reasons,” she wrote.
She also noted that, like many other victims of domestic abuse and coercive control, Mrs Nisbet may have felt “divided in her loyalties” and was “conflicted” about how the escalating risks should be managed, having told police she didn’t want to criminalise his behaviours.
“This is probably one of the more consistent barriers to criminal justice intervention where there is a family dynamic,” Professor Monckton-Smith observed.
Pictured: The police were called several times to the family home between April and August 2019.
Overall, the Professor found professionals, with the exception of the GP who recognised the “escalating danger” and sought on many occasions to get support from mental health services, hadn’t fully seen the risk to Mrs Nisbet until closer to the time of her death.
Following her review, Professor Monckton-Smith made a number of recommendations, which included the prioritisation of the proposed Domestic Abuse Law, and an updated Domestic Abuse Strategy, which is currently being developed.
She also recommended a ‘Think Family’ model to ensure the impact of behaviours and risks on family members is considered.
She called for a review of the pathway for crisis intervention and recommended that the opinion of a senior clinician is sought if a patient is not detained as a result of a difference of opinion.
Professor Monckton-Smith also made a number of recommendations to raise awareness of domestic abuse, especially coercive control, within the community but also among local agencies. She also urged for the creation of a programme to improve the “safety, wellbeing and quality of life of survivors and victims of domestic abuse”.
“This is in some ways a unique set of circumstances, but in other ways the patterns played out in a recognised way,” she wrote.
“It may be that hindsight helps us recognise the patterns more easily but increasing knowledge of coercive control and domestic abuse risk patterns in professionals and with society more generally, can help identify escalating risk.”
Mrs Nisbet's family were invited to contribute to the review, paying tribute to her community-minded character.
Not only was she a St. Peter Honorary Police Officer, but had also been a member of the Youth Court Panel, was a Rates Assessor, and had volunteered for charities including Riding for the Disabled, Age Concern and Jersey Cheshire Homes.
"Pamela always did as much as she could to help those less fortunate than herself, not only by working but by volunteering and giving her time to many charities," they wrote.
"People enjoyed her company because she had a warm welcoming personality and a good sense of humour. She was very knowledgeable and understood how some people struggle with life and did her upmost to help them. She had a great sense of community and a commitment to giving to those less fortunate than herself.
"Losing Pamela has left a huge void in many people’s lives and the pain of losing her will never fade. It will never go away and she will always be loved and remembered with fondness."
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